Citation Nr: 9816672
Decision Date: 05/29/98 Archive Date: 06/03/98
DOCKET NO. 96-50 118 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Houston,
Texas
THE ISSUE
Entitlement to an increased evaluation for psoriasis with
seborrheic dermatitis, currently evaluated at 10 percent.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
Robin M. Webb, Associate Counsel
INTRODUCTION
The veteran had active service from July 1974 to July 1976.
This appeal arises before the Board of Veterans' Appeals
(Board) from a rating action of the Department of Veterans
Affairs (VA) Regional Office (RO) in Houston, Texas, which
denied the veteranís claim of entitlement to an increased
rating for psoriasis with seborrheic dermatitis, currently
evaluated at 10 percent.
Service connection was granted for seborrheic dermatitis in
May 1989 and a zero percent disability rating was assigned.
Service connection for psoriasis was subsequently granted in
a July 1991 Board decision. The RO, in a February 1992
rating decision, then assigned a 10 percent disability
rating. This evaluation currently remains in effect and is
the subject of this appeal, pursuant to the veteranís June
1995 claim of entitlement to an increased evaluation which
was subsequently denied by the RO in May 1996.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends that he is entitled to an increased
evaluation for his psoriasis with seborrheic dermatitis.
Specifically, he asserts that he experiences constant
itching, has extensive lesions and marked disfigurement. He
also asserts that his skin condition has worsened and that he
cannot find employment because of this condition.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A.
ß 7104 (West 1991 & Supp. 1998), has reviewed and considered
all of the evidence and material of record in the veteran's
claims file. Based on its review of the relevant evidence in
this matter, and for the following reasons and bases, it is
the decision of the Board that
the evidence of record supports the grant of a 30 percent
disability rating for psoriasis with seborrheic dermatitis.
FINDINGS OF FACT
1. All evidence necessary for an equitable disposition of
the veteranís appeal has been obtained by the RO.
2. The veteranís service-connected skin disability is
manifested by clinical findings which include 3-5 millimeter
scaly patches and plaques on the veteranís trunk and
extremities, lichenified hyperpigmented scaly plaques on the
central and upper back, mild flaking on the veteranís face,
and mild flaking on the veteranís scalp; the disability
results in extensive lesions and marked disfigurement.
CONCLUSION OF LAW
The schedular criteria for an evaluation of 30 percent, but
no higher, for psoriasis with seborrheic dermatitis have been
met. 38 U.S.C.A. ßß 1155, 5107 (West 1991); 38 C.F.R. Part
4, ßß 4.7, 4.118, Diagnostic Codes 7806, 7816 (1997).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
I. Pertinent Law and Criteria
Disability ratings are based, as far as practicable, upon the
average impairment of earning capacity attributable to
specific injuries. 38 U.S.C.A. ß 1155;
38 C.F.R. ß 4.1. Generally, the degrees of disability
specified are considered adequate to compensate for
considerable loss of working time from exacerbations or
illnesses proportionate to the severity of the several grades
of disability.
38 C.F.R. ß 4.1. In evaluating the severity of a particular
disability, it is essential to consider its history.
38 C.F.R. ßß 4.1, 4.2 (1997).
In this instance, Diagnostic Code 7816 (Psoriasis) provides
for evaluation under the schedular criteria for eczema. See
38 C.F.R. Part 4, ß 4.118, Diagnostic Codes 7806, 7816.
Specifically, a 10 percent evaluation is warranted where the
veteranís disability is manifested by exfoliation, exudation
or itching, involving an exposed surface or extensive area.
38 C.F.R. Part 4, ß 4.118, Diagnostic Code 7806. The next
higher evaluation, thirty percent, is warranted where the
veteranís disability is manifested by constant exudation or
itching, extensive lesions, or marked disfigurement. Id. A
50 percent evaluation is warranted where the veteranís
disability is manifested by ulceration or extensive
exfoliation or crusting, and systemic or nervous
manifestations, or is exceptionally repugnant. Id. Where
there is a question as to which of two evaluations shall be
applied, the higher evaluation will be assigned if the
disability picture more nearly approximates the criteria
required for that rating. Otherwise, the lower rating will
be assigned. See 38 C.F.R. Part 4, ß 4.7.
II. Factual Background
The pertinent clinical evidence of record consists of VA
outpatient treatment records (dated from January 1994 to May
1995 and in August 1996), submitted in conjunction with the
veteranís latest claim of entitlement to an increased
evaluation, two VA examinations (conducted in October 1995
and in February 1997), and photographs of the veteran
submitted in conjunction with this appeal.
The veteranís VA outpatient treatment records, in an entry
dated in January 1994, reflect the veteranís history of
psoriasis and his report that it ďtends to come and goĒ and
that it had recently ďflared.Ē Physical examination
revealed scaly plaques on the veteranís trunk, arms, legs,
and especially buttocks. A subsequent entry, dated in April
1994, notes clinical findings of diffuse, well demarcated
flattened papulosquamous plaques. The recorded assessment
was psoriasis. Another entry dated in April 1994 also noted
psoriasis and recorded clinical findings of scaly, irregular
plaques all over the veteranís trunk and extremities, with
erythema. An August 1996 entry records diffuse, scaly
macules, plaques, and papules of pinkish color and scaling
over both arms, the anterior and posterior of the trunk, the
veteranís face, and both legs, with some lichenification.
The assessment was psoriasis and sebopsoriasis.
The VA examination conducted in October 1995 reflects the
veteranís complaints of pruritus, which is worse with cold,
dry weather, and his reports of ďflaresĒ in autumn and
winter. Listed medications included Cyclocort,
Hydrocortisone, Diprosone, Aquaphor, Atarax, and tar shampoo.
Physical examination found lichenified hyperpigmented plaques
on the veteranís elbows, knees, and scalp. The diagnosis was
psoriasis, given the appearance and distribution of the
veteranís lesions and his history.
The VA examination conducted in February 1997 notes the
veteranís history of receiving treatment for his psoriasis at
the VA Dermatology Clinic. It also notes that the veteran
has managed his psoriasis with topical steroid creams and
ointments, keratolytics, and various lubricants. The
examination reflects the veteranís complaints of occasional
ďflaresĒ with weather changes, marked by worsening of the
rash of the psoriasis, as well as with itching and burning of
the skin. It also reflects the veteranís report of only
using his topical medicine intermittently. Clinical findings
included scattered 3-5 millimeter scaly patches and plaques
on the veteranís extremities and trunk, lichenified
hyperpigmented scaly plaques on the veteranís central and
upper back, mild flaking on the face, and mild flaking on the
scalp, without any substantial erythema or plaque formation.
The skin was not well lubricated, with an overall dryness.
The impression recorded was psoriasis, not out of control, to
be managed with topical treatments only at this time. The
examiner noted that psoriasis is a chronic condition, for
which there is no cure, and that the veteran is going to have
occasional ďflaresĒ from time to time.
The photographs submitted in connection with this appeal
clearly demonstrate the presence of some skin disorder,
presumably psoriasis, and various discoloration of the skin.
III. Application
The Board notes that it has reviewed all of the pertinent
clinical evidence of record. In this instance, as discussed
below, the Board finds that a 30 percent evaluation, but no
higher, is warranted for the veteranís psoriasis with
seborrheic dermatitis.
Here, the veteran has been assigned a 10 percent disability
rating under the schedular criteria for eczema. See
38 C.F.R. Part 4, ß 4.118, Diagnostic Codes 7816, 7806.
Diagnostic Code 7806 provides for a 10 percent rating where
the veteranís disability is manifested by exfoliation,
exudation or itching, if involving an exposed surface or
extensive area. This same diagnostic code provides for a
30 percent evaluation where the veteranís disability is
manifested by constant exudation or itching, extensive
lesions, or marked disfigurement. Here, the Board notes that
Diagnostic Code 7806 does not require manifestation of all
criteria listed to warrant a 30 percent disability rating.
Review of the pertinent clinical evidence of record,
including particularly the photographs of the veteran, shows
that the veteranís disability, as manifested, more nearly
approximates the criteria for a 30 percent evaluation. Id.
Specifically, both VA examinations noted scaly patches and
plaques on the veteranís trunk and extremities. In addition,
the VA examination conducted in October 1995 found
lichenified hyperpigmented plaques on the veteran's elbows,
knees, and scalp. The February 1997 examination also found
lichenified hyperpigmented scaly plaques, this time on the
veteranís central and upper back. Also, all pertinent VA
outpatient treatment records reported plaques on the
veteranís trunk and extremities. Moreover, the VA examiner
in October 1995 equated the veteranís lichenified
hyperpigmented plaques to lesions, as summarized in the
recorded diagnosis. One medical definition of lesions is ďa
pathological change in tissues.Ē See STEDMANíS MEDICAL
DICTIONARY 955 (26th ed. 1995). Further, given the natural
coloring of the veteranís skin, the obvious discoloration on
his extremities and trunk serves as marked disfigurement.
As noted earlier, evidence of ulceration or extensive
exfoliation or crusting, and systemic or nervous
manifestations, or of an exceptionally repugnant nature, is
required to warrant the next higher rating of 50 percent.
See Diagnostic Code 7806. Here, the pertinent clinical
evidence of record fails to support that rating. The
clinical evidence of record is devoid of recorded findings of
ulceration, extensive exfoliation or crusting and systemic or
nervous manifestations. Nor does the evidence of record
support the conclusion that the veteranís disability, as
currently manifested, is exceptionally repugnant.
Therefore, in light of the above, the Board concludes that
the current symptomatology more nearly approximates the
schedular criteria for a 30 percent evaluation for the
veteranís psoriasis with seborrheic dermatitis and that an
increased evaluation is warranted.
ORDER
A 30 percent rating is granted for the veteranís psoriasis
with seborrheic dermatitis, subject to the applicable
provisions pertinent to the disbursement of monetary funds.
V. L. Jordan
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. ß 7266 (West
1991 & Supp. 1998), a decision of the Board granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals
(Court) within 120 days from the date of mailing of notice of
the decision, provided that a Notice of Disagreement
concerning an issue which was before the Board was filed with
the agency of original jurisdiction on or after November 18,
1988. Veterans' Judicial Review Act, Pub. L. No. 100-687,
ß 402, 102 Stat. 4105, 4122 (1988). The date which appears
on the face of this decision constitutes the date of mailing
and the copy of this decision which you have received is your
notice of the action taken on your appeal by the Board of
Veterans' Appeals.
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